1. FHM TRAINING TOOLS This training presentation is part of FHMs commitment to creating and keeping safe workplaces. Be sure to check out all the training programs that are specific to your industry.

2. Bioterrorism: An Overview Bioterrorism Preparedness and Response Program

3. Bioterrorism Bioterrorism Intentional or threatened use of viruses, bacteria, fungi, or toxins from living organisms to produce death or disease in humans, animals, or plants

4. History of Biological Warfare 14th Century:Plague at Kaffa

6. History of Biological Warfare 18th Century:Smallpox Blankets

8. History of Biological Warfare 20th Century: –1943:USA program launched –1953:Defensive program established –1969:Offensive program disbanded

9. Biological Warfare Agreements 1925Geneva Protocol 1972Biological Weapons Convention 1975Geneva Conventions Ratified

10. Bioterrorism

11. Bioterrorism : Who are 1st Responders? Primary Care Personnel Hospital ER Staff EMS Personnel Public Health Professionals Other Emergency Preparedness Personnel Laboratory Personnel Law Enforcement

12. Potential Bioterrorism Agents Bacterial Agents –Anthrax –Brucellosis –Cholera –Plague, Pneumonic –Tularemia –Q Fever Viruses –Smallpox –VEE –VHF Biological Toxins –Botulinum –Staph Entero-B –Ricin –T-2 Mycotoxins

13. Biological Agents of Highest Concern Variola major (Smallpox) Bacillus anthracis (Anthrax) Yersinia pestis (Plague) Francisella tularensis (Tularemia) Botulinum toxin (Botulism) Filoviruses and Arenaviruses (Viral hemorrhagic fevers) ALL suspected or confirmed cases should be reported to health authorities immediately

14. Smallpox

15. ParapoxAnthrax

16. Advantages of Biologics as Weapons Infectious via aerosol Organisms fairly stable in environment Susceptible civilian populations High morbidity and mortality Person-to-person transmission (smallpox, plague, VHF) Difficult to diagnose and/or treat Previous development for BW

17. Advantages of Biologics as Weapons Easy to obtain Inexpensive to produce Potential for dissemination over large geographic area Creates panic Can overwhelm medical services Perpetrators escape easily

18. Bioterrorism: How Real is the Threat? Hoax vs. Actual BT Event

19. Anthrax Bioterrorism San Francisco Chronicle, 20 December 1998

21. Threats reported to FBI

23. Chemical & Biological Terrorism Chemical & Biological Terrorism 1984: The Dallas, Oregon, Salmonella (salad bar) 1991: Minnesota, ricin toxin (hoax) 1994: Tokyo, Sarin and biological attacks 1995: Arkansas, ricin toxin (hoax) 1995: Ohio, Yersinia pestis (sent in mail) 1997: Washington DC, Anthrax (hoax) 1998: Nevada, non-lethal strain of B. anthracis 1998: Multiple Anthrax hoaxes

24. Salmonellosis Caused by Intentional Contamination 4 The Dalles, Oregon in Fall of 1984 4 751 cases of Salmonella 4 Eating at salad bars in 10 restaurants 4 Criminal investigation identified perpetrators as followers of Bhagwan Shree Rajneesh

26. Clinical Status of Patients Exposed to Sarin on March 21, 1995 Dead 8 Critical 17 Severe 37 Moderate 984 Outpatient4,073 Unknown 391 Total5,510

27. Shigellosis Caused by Intentional Contamination 4 Dallas, Texas in Fall of 1996 4 12 (27%) of 45 laboratory workers in a large medical center had severe diarrheal illness 4 8 (67%) had positive stool cultures for S. dysenteriae type 2 4 Eating muffins or donuts in staff break room implicated 4 PFGE patterns indistinguishable for stool, muffin, and laboratory stock isolates 4 Criminal investigation in progress

28. Federal Agencies Involved in Bioterrorism NSC DOD FEMA DOJ DHHS Treasury EPA FBI PHS CDC Secret Service USDA FDA SBCCOM USAMRIID OEP

29. Cost of Bioterrorism

30. Agent Transmission

31. Routes of Infection Routes of Infection Skin –Cuts –Abrasions –Mucosal membranes

32. Routes of Infection Routes of Infection Gastrointestinal –Food Potentially significant route of delivery Secondary to either purposeful or accidental exposure to aerosol –Water Capacity to affect large numbers of people Dilution factor Water treatment may be effective in removal of agents

33. Routes of Infection Respiratory –Inhalation of spores, droplets & aerosols –Aerosols most effective delivery method –1-5F droplet most effective

34. Medical Response to Bioterrorism

35. Medical Response Pre-exposure –active immunization –prophylaxis –identification of threat/use

36. Medical Response Incubation period –diagnosis –active and passive immunization –antimicrobial or supportive therapy

37. Medical Response Overt disease –diagnosis –treatment may not be available may overwhelm system may be less effective –direct patient care will predominate

38. Public Health Response to Bioterrorism

39. Priorities for Public Health Preparedness Emergency Preparedness and Response Enhance Surveillance and Epidemiology Enhance Laboratory Capacity Enhance Information Technology Stockpile

40. Components of a Public Health Response to Bioterrorism Detection - Health Surveillance Rapid Laboratory Diagnosis Epidemiologic Investigation Implementation of Control Measures

41. Laboratory Response Network For Bioterrorism Level-A Lab Use Class II Biosafety Cabinet A - Rule-out and forward organisms Level B Lab BSL-2 facility + BSL-3 Safety Practices B - Limited confirmation and Transport Level C Lab BSL-3 C - Molecular assays, reference capacity D - Highest level characterization (Federal) Level D Lab BSL-4

42. CDC Rapid Response and Advanced Technology Lab CDC BT Rapid Response and Advanced Technology Lab BSL -3 Agent Identification and Specimen Triage Refer to and Assist Specialty Lab Confirmation Evaluate Rapid Detection Technology Rapid Response Team

43. Bioterrorism : What Can Be Done? Awareness Laboratory Preparedness Plan in place Individual & collective protection Detection & characterization

44. Bioterrorism: What Can Be Done? Emergency response Measures to Protect the Publics Health and Safety Treatment Safe practices